Periodontal Disease

at Capital Periodontics and Dental Implants

About Periodontal Disease

Periodontal disease (gum disease) is an inflammatory disease which affects the tissues supporting the teeth (the gums or gingiva, periodontal ligament and the alveolar bone).

Common symptoms of periodontal disease include bad breath, redness and bleeding of the gums, swelling of the gums. In the later stages this may be followed by receding gums and loose, drifting teeth, which may results in spacing between the teeth.

When this condition is only present in the more superficial gum tissue, it is known as Gingivitis. This is a common condition and is easily treated. However, when inflammation has progressed to deeper structures such as the alveolar bone, it is known as Periodontitis or periodontal disease. This can be a progressive disease, which may gradually destroy the supporting tissues of the teeth and lead to tooth loss.

What is the cause?


Periodontal disease is an inflammatory condition caused by dental plaque (a film of the bacteria present in the mouth that forms on the teeth). If dental plaque is allowed to accumulate in the space between the gums and the tooth surface, the gums (gingiva) will mount an inflammatory response to the bacteria, which is called Gingivitis. Because inflammation increases the blood supply to the affected area to recruit white blood cells to combat the bacteria, the gums may appear reddened and bleed easily.

In some people, gingivitis may progress to Periodontitis. This occurs when the white blood cells fighting the bacteria within dental plaque cause destruction of the important tissues supporting the teeth (the periodontal ligament and the alveolar bone). Over time (months, years and even decades) this may lead to adverse signs such as loosening and drifting of teeth.

Can Anyone Develop Periodontal Disease?

It seems that everyone can develop gingivitis if they fail to maintain good oral hygiene and allow dental plaque to accumulate. Fortunately, the progression of Gingivitis to Periodontitis does not occur in everyone. In fact, only about 15% of the population appears to be at risk of losing their teeth to severe periodontal disease.

How is it Treated?

The aim of periodontal treatment is to restore the health of the gums, periodontal ligament and alveolar bone by reducing the bacterial deposits on the teeth. This is achieved though a combination of professional removal of the bacterial deposits from the roots of the teeth and maintaining a high standard of personal oral hygiene to prevent reformation of dental plaque on the teeth.

In most situations, a non-surgical approach under local anaesthetic (similar to other dental procedures) is effective in removing the bacterial deposits with a combination of ultrasonic and hand instruments.

Sometimes, if the bacterial deposits are deep under the gums, it may be necessary to carry out surgery on the gums (again under local anaesthetic) to gain access to the bacteria. Antibiotics may be used in combination with non-surgical or surgical treatment in some situations.


What else contributes?

We know that bacteria can cause periodontal disease, but there are a number of contributing or risk factors which increase the likelihood of progressing from Gingivitis to Periodontitis and increase the rate of progression of the disease. Genetics The white blood cell response that leads to destruction of periodontal tissue may be genetically determined. This is why some people with poor oral hygiene (and hence heavy deposits of bacterial plaque on their teeth) don’t progress from Gingivitis to Periodontitis, whereas other people who take much better care of their teeth can develop Periodontitis with relatively small amounts of dental plaque. A family history of periodontal disease may place you at greater risk of developing periodontal disease. Smoking Smoking is the chief environmental factor that contributes to severity of periodontal disease. Heavy smokers (both of tobacco and marijuana) have an impaired healing response which has a detrimental effect on the course of untreated periodontal disease and diminishes the benefits of periodontal treatment when compared with non smokers.

What are the other risk factors?

Diabetes which can compromise the immune system or the healing of wounds, will worsen periodontal disease and slow the healing process following treatment. Stress is known to have a detrimental effect on the immune system (particularly on certain types of white blood cells) and has been shown to contribute to worsening of periodontal disease. Obesity is associated with a greater susceptibility to periodontal disease and disease severity. Poor nutrition can contribute to poor health and a compromised immune response resulting in diminished wound healing, and a worsened periodontal condition. Clenching and grinding of teeth may increase loss of alveolar bone around teeth already affected by periodontal disease. Tooth clenching and grinding (bruxing activity) will often contribute to sensitivity of teeth following periodontal treatment. Medications some medications can contribute to unusual responses of the gums to dental plaque such as enlargement and ulceration which may increase susceptibility to periodontal disease

Is it linked to other systemic diseases and conditions?

There is a body of research linking periodontal disease to cardiovascular disease, diabetes, low birth weight and pre-term infants and several other conditions.

Can anyone develop periodontal disease?

It seems that everyone can develop gingivitis if they fail to maintain good oral hygiene and allow dental plaque to accumulate. Fortunately, the progression of Gingivitis to Periodontitis does not occur in everyone. In fact, only about 15% of the population appears to be at risk of losing their teeth to severe periodontal disease.

What are the side effects of periodontal treatment?

Periodontal treatment will not predictably restore the lost periodontal ligament and alveolar bone supporting the roots of teeth. Significant recovery of periodontal ligament and bone can be achieved in certain situations, whereas in others such recovery is rarely achieved, even with the use of regenerative materials available today. For the most part, periodontal treatment is aimed at preserving the remaining periodontal tissue support for the teeth through healing of these tissues. One obvious effect of the control of inflammation and swelling is tissue shrinkage. This can cause the gum to recede further as it returns to its “true” volume. This can expose more root surface of the tooth, resulting in sensitivity of the teeth, especially to cold drinks, which usually improves with time.

How can i stop periodontal disease recurring?

Periodontal treatment is aimed at healing the periodontal tissues, but does not necessarily change someone’s susceptibility to future periodontal disease. For this reason, people who have been successfully treated should be carefully monitored on a regular basis and have professional cleaning of the teeth at these visits to prevent disease recurrence. This is usually done by a dental hygienist who will ensure that oral hygiene is of a good standard and that bacterial deposits are kept to a minimum on the teeth. Occasionally, some sites may require further treatment if recurrence of inflammation is detected.

What else do periodontists do?

Capital Periodontics offers a range of additional services such as: Aesthetic shaping of the gum tissues in preparation for new crowns or veneers on front teeth. This is called periodontal plastic surgery. Crown Lengthening: sometimes it is necessary to remove some periodontal tissue to expose more of the tooth so that the dentist is able to restore a fractured or decayed tooth. Mucogingival procedures to cover exposed root surfaces suffering from recession of the gum. Ridge augmentation procedures in preparation for new bridgework or dental implants. Orthodontic surgery to uncover impacted canine teeth.

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